Job Details & Requirements
- Requires an RN with an unrestricted active license
- 3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- Case Management Certification CCM preferred.
- 8 – 5 PM, Monday through Friday
Job Description
The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy to identify options and services that meet an individual’s benefit plan and/or health needs, leveraging available resources and communication to promote optimal, cost-effective outcomes. Requires an RN with an unrestricted active license.
Using clinical tools and information/data review, conducts comprehensive assessments of referred members’ needs/eligibility and determines the approach to case resolution and/or meeting needs by evaluating members’ benefit plans and available internal and external programs/services. Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members’ needs to ensure appropriate administration of benefits. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Skills & Experience
- 3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- Healthcare and/or managed care industry experience.
- Case Management experience preferred.
- Requires proficiency with computer skills, which include navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written.
- Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.
Work Environment
- Sedentary work involves periods of sitting, talking, and listening.
- Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
- Work requires the ability to perform close inspection of handwritten and computer-generated documents, as well as a PC monitor.
- Typical office working environment with productivity and quality expectations.
Education
- RN with current unrestricted state licensure.
- Case Management Certification CCM preferred
Schedule: 8 – 5 PM, Monday through Friday
Job Pay Rate: $44.00